Some women have to travel substantial distances to access abortion services, which can increase costs, decrease convenience and limit access, according to Rachel Jones and Jenna Jerman of the Guttmacher Institute. Thirty-five percent of U.S. women live in the 87% of counties that have no abortion provider, they noted.

Distance-related obstacles are compounded by legal restrictions, such as waiting periods. Waiting periods are particularly burdensome when coupled with mandatory in-person counseling sessions, which necessitate two clinic visits, the researchers wrote.

"As of January 2013, 35 states had implemented mandated waiting periods [for abortions], up from 25 in 2008," according to Jones and Jerman. They developed a study to assess the distance women traveled for abortion services in 2008, in order to serve as a "baseline for monitoring issues related to distance traveled for abortion services."

Methods

Jones and Jerman used data from the Guttmacher Institute's 2008 Abortion Patient Survey, which included information from 107 randomly selected abortion facilities. Surveys distributed to women obtaining abortion services at the facilities resulted in 9,493 usable responses from women residing in 47 states, who obtained abortions at 95 facilities in 34 states. The respondents provided demographic information and their ZIP codes.

The analysis focused on how far away patients lived from the facilities where they obtained abortions. The researchers also assessed whether women lived in a state with a 24-hour waiting period with a two-visit requirement, a state with only a 24-hour waiting period, or a state with no waiting period or visit requirements.

Results

The analysis revealed that about 67% of patients traveled fewer than 25 miles to access abortion services, while 16% traveled 25 to 49 miles, and 6% traveled more than 100 miles. The researchers noted that several factors affected how far the women traveled. For example, "[W]omen who lived in a state with a 24-hour waiting period were at least four times as likely to have traveled 100 or more miles," compared with those living in a state without a waiting period.

Distance traveled also varied by region. The analysis found that larger proportions of women living in the Northeast and the West traveled fewer than 25 miles, compared with women in the South and Midwest who were more likely to travel more than 100 miles. Women living outside of a metropolitan area were "many times more likely" to have traveled "each increasing category of distance," the researchers found.

For example, adjusting for all other factors, the predicted probability of rural women traveling more than 100 miles for an abortion was about 24%, compared with just 2% for urban women. Overall, 31% of rural women traveled more than 100 miles.

Race and ethnicity played a role as well. Non-Hispanic white women were most likely to have traveled the greatest distances to obtain an abortion, while Hispanic women traveled the least. Further, women with higher income levels and those who were able to use Medicaid or private insurance coverage for their care were less likely to have to travel far distances than those paying out of pocket or relying on financial services for support.

The researchers conducted a subanalysis of rural women "[b]ecasue of the unexpectedly strong association between residing in a rural area and distance traveled." The subanalysis found that greater proportions of rural women "lived in a state with a waiting period, resided in the Midwest or the South, were white, born in the US and crossed state lines for abortion services."

Discussion and Conclusion

Jones and Jerman wrote, "Our estimate of distance traveled is substantially lower than previously published national estimates based on information from providers, but similar to a more recent study of abortion patients in Iowa that used a methodology comparable to ours." However, they noted, "We expect that our estimate, based on information provided by patients, is more precise."

They cautioned that focusing on the proportion of women who travel more than 50 miles "would be misleading, as it may obscure the burden faced by women who are unable to travel long distances." Although rural women tend to have to travel farther for many types of services, the fact that they are underrepresented among abortion patients suggests "that at least some of this underrepresentation is due to difficulties finding and getting to [abortion] providers that are so far away," the researchers wrote.

Noting that "reduced access to care extends to other reproductive health outcomes," such as "inadequate prenatal care," the researchers wrote that "[t]elemedicine has the potential to increase access to health care and improve the quality of life for individuals who live in rural areas." However, they also noted that several states with substantial rural populations have since introduced measures restricting telemed abortion services.

The researchers added that their findings are intended as a baseline for monitoring abortion access with regard to distance. "If the number of providers resumes its decline, more women will have to travel farther to access services and, for some, the additional obstacle of travel could prevent them from obtaining abortions," they wrote. They concluded, "[I]f Roe v. Wade were overturned, an average women would have to travel an additional 157 miles" -- five times farther than most women currently travel -- to access abortion care in states where it would still be legal, which "would almost certainly" reduce access.

Video Round Up

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Datapoints

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At A Glance

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— Nancy Northup, president and CEO of the Center for Reproductive Rights, on a ruling from the 5th U.S. Circuit Court of Appeals that upheld major portions of a Texas antiabortion-rights law. Read more